Laserfiche WebLink
� <br /> City of Orono - -9jI� <br /> Building Permit Application ) 1 <br /> for New Structures or Additions <br /> Mailing Address: Permit number: 6;z6 / _Q <br /> PO Box 66 <br /> `wQ Crystal Bay, MN 55323-00 Date received: Y,61—J(42 <br /> Street Address:' 'kllw\ <br /> \ Received by: r� <br /> s � <br /> 2750 Kelley Parkway � Plan review fee: /J 3 /02 .S/Orono, MN 55356 <br /> �kESHo��` Main: 952-249-4600 Total Fee: p�0/ &-603,'S <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: 1 <br /> Job Site Address: 3�6!r �-� tLe caw to Rd <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/Apf .ICAYT INFO ATION: <br /> Name: U v� '— <br /> State License# 6 Expiration Date: s! <br /> Phone: cell Z office -11 D <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: Applicant is: ontrac o / Homeowner (Circle One) <br /> Email and/or Fax: — QIIMQ <br /> PROPERTY OWNE�INFORMATI N: <br /> Name: J�•4toSam <br /> Phone (day): <br /> Address: 5"]Q I ` unhy /`SIL L A City: MokW ZIP: <br /> Email and/or Fax t-kAa!h in _ cul& brae-1 E_ e-am <br /> ARCHITECT/ENGINEER LNFORMATI �! / t, <br /> Name: K�(,d.0—t) QV-,lt " <br /> Phone (day): V V ¢OV *U, <br /> Address: OtloO AA-V%ffid r V6City:& NV_ KW ZIP: <br /> Email and/or Fax: IN 4.0 gp AFP CJ eSknN , r <� <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> JeNew Construction Single Family with ElAccessory Bldg./Garage <br /> ❑Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with Office/Commercial <br /> ❑ Relocation detached garage Residence 'd Private Sewer <br /> ❑Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse X Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ 75� 000 RECEIVED <br /> APR 0 1 2016 <br /> Packet Last Updated: August 2015 <br /> Page 21 CITY OF ORONO <br />